Renal and perirenal lymphoma: arteriographic findings.

Abstract

THIS COMMUNICATION reports the arteri-ographic changes seen in two patients with renal and perirenal lymphoma. In both instances an arteriogram was obtained during routine radiologic work-up for evaluation of a renal mass. At the time of arteriography, the clinical diagnosis of lymphoma was not suspected. Case Reports CASE I: G.W., a 70-year-old man, entered the hospital because of intermittent painless gross hematuria of two months duration. There had been a 10-to 15-lb. weight loss during the preceding six months. On admission, physical examination disclosed a palpable, firm, nontender mass in the left flank which did not move with respiration. The blood count revealed hemoglobin of 12 g per 100 ml and hematocrit of 39 per cent. Urinalysis showed numerous red blood cells per high-power field, and a urine hematest was positive. Other laboratory tests were normal. An intravenous urogram revealed a normal right kidney and nonfunctioning left kidney, and retrograde pyelography demonstrated obstruction of the left ureter below the pelvic brim. The diagnosis of renal-cell carcinoma was suspected. A renal arteriogram disclosed narrowing of the main renal artery and a fine net of vessels in a markedly thickened capsule surrounding the kidney. The renal vein was compromised, and venous drainage was through multiple collaterals (Fig. 1). At surgery, the kidney was found to be enlarged, hard, and fixed to the left retroperitoneal area. Tumor infiltrated the kidney. The capsule was markedly thickened, and tumor surrounded the aorta and extended into the base of the mesentery. The kidney and perirenal tissue were the only areas involved. The histological diagnosis of biopsy was malignant lymphoma, lymphoblastic type. CASE II: F.S., a 59-year-old man, was admitted to the hospital for the evaluation of fever of unknown origin, anemia, weakness, and a 20-lb. weight loss. On admission, physical examination revealed an anemic-appearing male whose liver and spleen were slightly enlarged. The physical examination was otherwise unremarkable. Blood count indicated anemia with hemoglobin 9.2 per 100 ml and hematocrit 34 per cent. Other laboratory tests were normal. On the intravenous urogram a large soft-tissue mass closely associated with the lower pole of the right kidney was recognized. The upper gastroin- testinal and barium enema studies merely demonstrated displacement of the bowel by the mass. Arteriography showed that the tumor was supplied by vessels arising from the capsule of the right kidney (Fig. 2). Early venous filling was also noted. At surgery, a 23 × 12-cm tumor was encountered, arising from the capsule of the lower pole of the right kidney and engulfing its lower half. The tumor was well encapsulated and did not invade the kidney or surrounding tissues.